Sinemet (co-careldopa)

What is Sinemet used for?

How does Sinemet work?

Sinemet tablets, Sinemet Plus tablets, Sinemet CR tablets and Half-Sinemet CR tablets all contain the active ingredients levodopa and carbidopa. This combination of medicines is also known as co-careldopa. It is used in Parkinson's disease to increase the levels of dopamine in the brain.

Dopamine is a substance called a neurotransmitter. It acts as a chemical messenger between nerve cells in the brain and nervous system. People with Parkinson's disease have lower amounts of dopamine in certain parts of their brains. This causes problems with the nerve messages that are sent from the brain to muscles and results in the symptoms of the disease, such as stiff muscles, slow movements and shaking.

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The levodopa in Sinemet is converted into dopamine in the brain and this replaces the lost dopamine. This helps to improve the nerve messages that are sent to the muscles and reduces some of the symptoms of Parkinson's disease.

The carbidopa in Sinemet stops levodopa being converted into dopamine in the rest of the body, as this can cause unwanted side effects such as nausea and palpitations. Carbidopa doesn't pass into the brain and so doesn't affect the conversion of levodopa to dopamine in the brain.

How do I take Sinemet?

The Sinemet dosage prescribed by your doctor will vary from person to person. Your dose will usually be increased gradually every day, or every other day, until your symptoms are under control. Always follow the instructions given by your doctor regarding the dose of Sinemet you should take and how often to take it. These will also be printed on the dispensing label that your pharmacist has put on the medicine.

Sinemet tablets and Sinemet Plus tablets are usually taken three or four times a day. Follow the instructions given by your doctor. The tablets can be taken either with or without food. They should be swallowed with a drink.

Sinemet CR tablets and Half Sinemet CR tablets are usually taken twice a day. These tablets are designed to release the medicine slowly as they pass through the gut, to help provide a steady blood level of the medicine throughout the day. This helps avoid high levels of the medicine that can make you feel sick and can also help avoid symptoms that come back because a dose is wearing off. This type of tablet must be swallowed whole with a drink and not broken, chewed or crushed, as this would damage the controlled-release action. The tablets can be taken either with or without food.

It's worth noting that protein-rich foods (for example meat, fish, eggs, cheese, beans and pulses) can reduce the absorption of levodopa from your gut, so it may be best to take your doses about an hour before meals. If you find taking Sinemet makes you feel sick this can be improved by taking your dose with a low protein snack such as a cracker. You can get more advice from your pharmacist. Remember that protein is essential for a healthy diet, so get advice from your specialist before making any changes to what you eat.

Try to always take your doses at the same times each day. If you forget to take a dose of Sinemet take it as soon as you remember, unless it is nearly time for your next dose. In this case leave out the missed dose and take your next dose as usual when it's due. Do not take a double dose to make up for a missed dose. Talk to your pharmacist if you have trouble remembering to take your medicine.

You should keep taking Sinemet every day until your doctor tells you to stop. Don't suddenly stop taking it without consulting your doctor, as this can cause withdrawal symptoms.

What should you know about taking Sinemet?

Sinemet may cause a reddish discolouration of your urine and other body fluids, such as sweat and saliva. This is normal and not harmful.

You may find that Sinemet makes you feel dizzy or unsteady when getting up from lying down or sitting, especially when you first start taking the medicine or after a dose increase. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.

Sinemet can make you feel sleepy, and on rare occasions people taking Sinemet have suddenly fallen asleep without warning during their daily activities. Although this is rare, you should take care when driving or performing other potentially hazardous activities. If you feel sleepy or if you have suddenly fallen asleep without warning you shouldn't drive or operate machinery.

Take care when drinking alcohol or taking other medicines that cause drowsiness, as these will make you more likely to feel sleepy.

When your symptoms start to improve, make sure you resume your normal activities gradually. Try not to do too much too quickly as you may risk injury.

Sometimes, people taking levodopa can develop impulse control disorders, such as gambling problems, binge eating, compulsive shopping, increased sex drive and hypersexuality. If you think this medicine is affecting you in this way, you should consult your doctor.

Can I take Sinemet while pregnant or breastfeeding?

Sinemet should not be used during pregnancy as it may be harmful to an unborn baby. Women who could get pregnant should use an effective method of contraception to prevent pregnancy while taking this medicine. Seek medical advice from your doctor. If you get pregnant while taking Sinemet then you should consult your doctor as soon as possible.

Levodopa passes into breast milk. It's not known if careldopa passes into breast milk. It is recommended that mothers taking Sinemet should not breastfeed. Get more advice from your doctor.

What are the possible side effects of Sinemet?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with co-careldopa. Just because a side effect is stated here doesn't mean that all people taking Sinemet will experience that or any side effect.

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Disturbances of the gut such as diarrhoea, nausea and vomiting.

Loss of appetite.

Dry mouth.

Change in the way things taste.

Feeling dizzy or lightheaded, particularly when standing up. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.

Feeling sleepy and sometimes suddenly falling asleep without warning. Do not drive if affected.

Feeling weak or tired.

Difficulty sleeping (insomnia).

Mood changes, strange or abnormal thoughts, delusions, hallucinations, anxiety or depression. Tell your doctor if you feel the medicine is affecting you in this way.

Confusion.

Palpitations or irregular heartbeats.

Jerky or involuntary movements, muscle twitches, or doses wearing-off, with long-term treatment. You should tell your doctor if you experience these problems.

Restless leg syndrome.

Skin rashes and itching.

Bleeding or ulceration in the stomach or intestines.

Disturbances in the normal numbers of blood cells in the blood.

Impulse control disorders such as binge eating, compulsive gambling or spending, increased sex drive (libido) and excessive interest or involvement in sexual activity (hypersexuality). Tell your doctor if you feel the medicine is affecting you in this way.

While taking Sinemet your doctor will want you to have regular tests to monitor your liver, kidneys, heart and blood cells.

Can I take other medicines with Sinemet?

It's important to tell your doctor or pharmacist what medicines you're already taking, including those bought without a prescription and herbal medicines, before you start treatment with Sinemet. Similarly, always check with your doctor or pharmacist before taking any new medicines while you're taking Sinemet, to make sure that the combination is safe.

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Iron reduces the absorption of levodopa from the gut. If you need to take an iron supplement such as ferrous sulphate, you should try to take this two to three hours before or after taking a dose of Sinemet. Ask your pharmacist for more advice.

You're more likely to feel dizzy, particularly when getting up, if you take other medicines that can lower your blood pressure while you're taking Sinemet. These include medicines used to lower high blood pressure and medicines that can lower blood pressure as a side effect. Get advice from your doctor or pharmacist if you find you feel dizzy when taking any other medicine alongside your Sinemet.

antipsychotic medicines, such as amisulpride, chlorpromazine, prochlorperazine, haloperidol, flupentixol (equally levodopa may oppose the effect of these medicines)

antispasmodics, eg hyoscine, atropine

benzodiazepines, such as diazepam

isoniazid

metoclopramide

nefopam

phenytoin

tetrabenazine

tricyclic antidepressants, eg amitriptyline, imipramine.

Co-careldopa can be used with other medicines for Parkinson's disease, for example anticholinergics, amantadine, selegiline, dopamine agonists such as ropinirole or COMT inhibitors such as entacapone, however, both the desired effects and side effects of treatment may be intensified. Your doctor may need to adjust the dose of one or more of your medicines to get the correct balance to control your symptoms with minimum side effects.

What other medicines contain levodopa and carbidopa?

Caramet CR modified-release tablets.

Duodopa intestinal gel.

Lecado modified-release tablets.

Co-careldopa tablets and modified-release tablets are also available without a brand name, as the generic medicine.

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.